Inverse Association Between Stature and Coronary Artery Disease and Stroke Risk: Height‐ Blood Pressure Relations as a Contributing Mechanism

Although recognized for half a century or more, the mechanisms linking stature and coronary artery disease and stroke (hemorrhagic/ischemic) risk remain elusive. Several theories have been proposed, although a definitive mechanism is lacking. Small‐scale, largely experimental, studies support the hypothesis that blood pressure (BP) components (systolic, diastolic, pulse, and mean; SBP, DBP, PP, MBP) are physiologically linked with dynamic vascular system features and height. The aim of the current study was to test the hypothesis that adult stature is associated with a distinct BP pattern consistent with epidemiological cardiovascular and cerebrovascular outcomes by extending experimental observations to a representative sample of the US population. The evaluated sample included 11,602 non‐Hispanic (NH) white, NH black, and Mexican American participants (6,089 male; 5,513 female) in the 1999–2004 National Health and Nutrition Examination Survey (NHANES) who had complete measurements of height, weight, % fat, SBP, and DBP; PP and MBP were calculated as SBP‐DBP and DBP+1/3(SBP‐DBP), respectively. Subjects taking BP medications and a history of high BP were excluded from the analyses. The analysis aim was to establish if height remains a significant BP predictor variable after controlling for age, body mass index (BMI), and % fat in multiple regression models. With 4 BP measures and 6 sex and race/ethnic groups, 24 initial regression models were created. Height was a significant (p<0.05) predictor variable in 14 of these 24 models. Combined sex‐specific models were developed for each BP measure with race/ethnicity as a covariate. Height was a significant (p<0.01) predictor in all 8 of these BP regression models; NH black subjects had higher SBP, DBP, PP, and MBP in the 8 models (p<0.05). The findings were consistent across men and women: greater height was associated with lower SBP and PP and higher DBP and MBP. Greater height in US adults is thus accompanied by a distinct BP pattern across US NH white, NH black, and Mexican American men and women. The observed height‐BP pattern is consistent with earlier small‐scale human experimental studies that provide a mechanistic basis for these effects. These findings suggest height‐associated BP effects may contribute to the greater coronary artery disease and stroke risk in people who are short relative to their tall counterparts.